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Hawaii ranks 5th nationwide in funding programs that prevent kids from smoking and help smokers quit, according to a report released today by leading public health organizations. Hawaii is spending $6.6 million this year on tobacco prevention and cessation programs, which is 48.1 percent of the $13.7 million recommended by the Centers for Disease Control and Prevention (CDC).

The report challenges states to do more to fight tobacco use – the nation’s leading cause of preventable death – and make the next generation tobacco-free. In Hawaii, 9.7 percent of high school students smoke, and 500 kids become regular smokers each year. Tobacco use claims 1,400 Hawaii lives and costs the state $526 million in health care bills annually.

Other key findings in the report include:

Hawaii will collect $163.9 million in revenue this year from the 1998 tobacco settlement and tobacco taxes, but will spend only 4 percent of the money on tobacco prevention programs.

Tobacco companies spend $25.5 million each year to market their deadly and addictive products in Hawaii – almost 4 times what the state spends on tobacco prevention. Nationwide, tobacco companies spend $8.9 billion a year on marketing – that’s $1 millionevery hour.

Hawaii has been a leader in the fight against tobacco. It has a high cigarette tax ($3.20 per pack, 5th among the states), a comprehensive smoke-free law, and in 2015 became the first state to raise the tobacco age to 21. This year Hawaii increased tobacco prevention funding by 25 percent (to $6.6 million), the first increase since 2012. However, total funding is still less than half what the CDC recommends.

“Hawaii has made tremendous progress, but needs to continue and increase its investment in preventing kids from smoking and helping smokers quit,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We can win the fight against tobacco and make the next generation tobacco-free, but Hawaii must keep doing its part to help achieve these goals.”

The U.S. has reduced smoking to record lows – 15.1 percent among adults and 8 percent among high school students. But tobacco use still kills more than 480,000 Americans and costs the nation about $170 billion in health care bills each year.

Today’s report also highlights large disparities in who smokes and who suffers from tobacco-related diseases in the United States. Smoking rates are especially high in a swath of 12 states in the Midwest and South, an area called “Tobacco Nation” in a recent Truth Initiative report. Nationwide, smoking rates are highest among people who live below the poverty level and have less education, American Indians/Alaska Natives, LGBT Americans, those who are uninsured or on Medicaid, and those with mental illness. These differences are in large part due to the tobacco industry’s targeting of vulnerable populations through advertising, price discounting and other marketing strategies.

By funding tobacco prevention and cessation programs at the CDC’s recommended levels, states can reduce tobacco use among all Americans. But most states are falling far short:

The states will collect $27.5 billion this year from the tobacco settlement and tobacco taxes, but will spend less than 3 percent of it ($721.6 million) on tobacco prevention programs.

The $721.6 million that the states have budgeted for tobacco prevention is a small fraction of the $3.3 billion the CDC recommends. Not a single state funds tobacco prevention programs at CDC-recommended levels, and only two states – California and Alaska – provide more than 90 percent of the recommended funding.

States with well-funded, sustained tobacco prevention programs have seen remarkable progress. Florida, with one of the longest-running programs, has reduced its high school smoking rate to 5.2 percent, one of the lowest rates ever reported by any state.